Molecular and cellular landscapes of the immune microenvironment and multiomic biomarker-sets in platinum-resistant recurrent ovarian cancers

Ovarian cancer is the deadliest gynecological malignancy, posing a significant threat to women’s health worldwide. Platinum-based chemotherapy remains the cornerstone of ovarian cancer treatment. Although most patients initially exhibit platinum sensitivity, recurrent disease frequently develops platinum resistance following multiple recurrences. Platinum-resistant recurrent ovarian cancer (PRROC) is associated with a poor prognosis. Current treatments offer limited clinical efficacy, yielding unsatisfactory outcomes overall. Across disease stages, from primary tumors to recurrent disease, the tumor microenvironment (TME) plays a critical role in cancer progression, immune evasion, and metabolic reprogramming. Accumulating evidence demonstrates that tumor metabolism is essential not only for supporting tumor growth and survival but also for shaping the TME through metabolite release. Furthermore, multiomics technologies, including genomics, transcriptomics, proteomics, and metabolomics, provide novel insights into the immune and molecular mechanisms underpinning tumor initiation, progression, immune escape, and drug resistance, suggesting new therapeutic avenues. This review explores how tumor metabolic reprogramming influences the TME and examines the role of the TME in facilitating immune evasion. We also discuss how multiomics approaches can deepen our understanding of the mechanisms by which tumors subvert immune surveillance through TME modulation and identify potential therapeutic targets.